The consumption of sugar-sweetened beverages has been suggested as a contributory factor to the rising levels of childhood obesity being recorded in many countries worldwide. Recent systematic reviews of the literature confirm the link between consumption of free sugars, particularly in the form of sugar-sweetened beverages and weight gain in both children and adults (1,2), while reducing intake of sugar-sweetened beverages has been shown to reduce weight gain in children, particularly in those who are already overweight (2–4).

While sugars are found naturally in many foods, including fruits and milk, the addition of sugars to food products adds to the total energy content of the product. Sugar-sweetened beverages contain sugars such as sucrose or high fructose corn syrup and a 330ml or 12oz portion of sugar-sweetened carbonated soft drink typically contains some 35g (almost nine teaspoons) of sugars and provides approximately 140 calories of energy, generally with little other nutritional value.

Evidence suggests that sugar-sweetened beverages are generally consumed quickly and do not provide the same feeling of fullness that solid food provides (5) such that consumers tend not to reduce intake of other foods sufficiently to compensate for the extra calories provided by sugar-sweetened beverages (6). Excess calories contribute to overweight and obesity as they can be readily converted to body fat and stored within various tissues. Overconsumption is likely exacerbated by an increase in the serving sizes of sugar-sweetened beverages over the last several decades (7).

Despite recommendations by medical experts and health organizations to limit consumption of sugar-sweetened beverages, sales of soft drinks, for instance, are increasing worldwide, particularly in low- and middle-income countries as a result of heavy marketing (8-13). Surveys of children and adolescents indicate that the majority are consuming one portion or more per day in countries as diverse as Ghana, Kuwait, Peru and Samoa – a higher level of consumption than reported in the USA and Western Europe (14–16). In Mexico, it is estimated that nearly 10% of total energy intake across all age groups comes from sugar-sweetened beverages (17,18).

Global patterns of consumption can exhibit variability with respect to socioeconomic status, as in high-income countries the greatest intake is often observed in populations with lower socioeconomic status (19), while the greatest intakes in low- and middle-income countries are frequently observed in populations with higher socio-economic status (12,20). These differences may have implications for formulation and implementation of nutrition interventions designed to reduce the consumption of sugar-sweetened beverages by children. Such interventions include:

• school-based health promotion in the classroom;
• rules about consuming soft drinks in schools;
• removal of vending machines selling soft drinks from school premises;
• provision of safe drinking water fountains in schools and other locations where children gather;
• public health education through social marketing campaigns;
• imposition of taxes or levies on sugar-sweetened beverages;
• reducing sugars content of sugar-sweetened beverages through mandatory reformulation by the food industry; and
• restricting the promotion and advertising of sugar-sweetened beverages on television and other media.

Regarding the marketing intervention mentioned in the last bullet point above, the Sixty-third World Health Assembly in May 2010 adopted resolution WHA63.14, which supports a set of recommendations to limit children’s exposure to the marketing of sugar-sweetened beverages, along with other food products high in saturated fats, sugars and salt. Though the larger, multinational beverage companies have voluntarily acted to reduce their marketing directed at children, these measures have not significantly reduced children’s exposure to marketing, especially their exposure through other media channels, including family-time television programmes and social digital media such as Facebook and Twitter (21). Marketing through social digital media can reach children directly, with little opportunity for parental control. Stronger, government-led measures may be needed to ensure that dietary advice is not undermined by commercial interests.

In summary, current evidence suggests that reducing sugars intake, especially in the form of sugar-sweetened beverages, may help maintain a healthy body weight. A range of interventions may be effective at achieving this goal.

References

1. Te Morenga L, Mallard S, Mann J. Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ. 2013; 346:e7492.

2. Malik VS, Pan A, Willett WC, Hu FB. Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. American Journal of Clinical Nutrition. 2013; 98(4):1084-102.

3. de Ruyter JC, Olthof MR, Seidell JC, Katan MB. A trial of sugar-free or sugar-sweetened beverages and body weight in children. New England Journal of Medicine. 2012; 367(15):1397-406.

4. Ebbeling CB, Feldman HA, Chomitz VR, Antonelli TA, Gortmaker SL, Osganian SK, Ludwig DS. A randomized trial of sugar-sweetened beverages and adolescent body weight. New England Journal of Medicine. 2012; 367(15):1407-16.

5. Pan A, Hu FB. Effects of carbohydrates on satiety: differences between liquid and solid food. Current Opinion in Clinical Nutrition and Metabolic Care. 2011; 14(4):385-90.

6. Bachman CM, Baranowski T, Nicklas TA. Is there an association between sweetened beverages and adiposity? Nutrition Reviews. 2006; 64(4):153–174.

7. Piernas C, Popkin BM. Increased portion sizes from energy-dense foods affect total energy intake at eating occasions in US children and adolescents: patterns and trends by age group and sociodemographic characteristics, 1977-2006. American Journal of Clinical Nutrition. 2011; 94(5):1324-32.

8.PepsiCo and Coca-Cola’s profit aided by growth in emerging markets [online document]. Foodnavigator-usa.com; 2011 (http://www.foodnavigator-usa.com/content/view/print/388021, accessed 3 December 2013).

9. Global Soft Drinks [online document]. London: MarketLine; 2013 (http://marketpublishers.com/report/consumers_goods/food_beverage/global_soft_drinks.html, accessed 1 September 2013).

10. Soft Drink Industry in India [online information service]. New Delhi: NIIR Project Consultancy Services; 2012 (http://www.niir.org/information/content.phtml?content=184, accessed 1 September 2013).

11. Brazil – Soft drinks. Industry Profile [online document]. London: MarketLine; 2013(http://www.datamonitor.com/store/Product/brazil_soft_drinks?productid=MLIP0929-0005, accessed 1 September 2013).

12. Taylor FC, Satija A, Khurana S, Singh G, Ebrahim S. Pepsi and Coca Cola in Delhi, India: availability, price and sales. Public Health Nutrition. 2011; 14(4):653-60.

13. Kleiman S, Ng SW, Popkin B. Drinking to our health: can beverage companies cut calories while maintaining profits? Obesity Reviews. 2012; 13(3):258-74.

14. Lasater G, Piernas C, Popkin BM. Beverage patterns and trends among school-aged children in the US, 1989-2008. Nutrition Journal. 2011; 10:103.

15. Coca-Cola: 2012 Year in Review Online [online document]. Atlanta GA: The Coca-Cola Company; 2012 (http://www.coca-colacompany.com/annual-review/2012/pdf/TCCC_2012_Annual_Review.pdf, accessed 1 September 2013).

16. Naska A, Bountziouka V, Trichopoulou A; DAFNE Participants. Soft drinks: time trends and correlates in twenty-four European countries. A cross-national study using the DAFNE (Data Food Networking) databank. Public Health Nutrition. 2010; 13(9):1346-55.

17. Rivera JA, Muñoz-Hernández O, Rosas-Peralta M, Aguilar-Salinas CA, Popkin BM, Willett WC; Comité de Expertos para las Recomendaciones. Beverage consumption for a healthy life: recommendations for the Mexican population. Salud Publica de Mexico. 2008; 50(2):173–195.

18. Vergara-Castañeda A, Castillo-Martínez L, Colín-Ramírez E, Orea-Tejeda A. Overweight, obesity, high blood pressure and lifestyle factors among Mexican children and their parents. Environmental Health and Preventive Medicine. 2010; 15(6):358–366.

19. Pabayo R, Spence JC, Cutumisu N, Casey L, Storey K. Sociodemographic, behavioural and environmental correlates of sweetened beverage consumption among pre-school children. Public Health Nutrition. 2012; 15(8):1338–1346.

20. Ratnayake N, Ekanayake L. Soft drink consumption in Sri Lankan adolescents. Public Health Nutrition. 2012; 15(8):1333-7.

21. Galbraith-Emami S, Lobstein T. The impact of initiatives to limit the advertising of food and beverage products to children: a systematic review. Obesity Reviews. 2013; 14(12):960–974.

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Declarations of interests

Conflict of interest statements were collected from all named authors and no conflicts were identified.